Provider Demographics
NPI:1740717677
Name:MARTIN, JENNIFER CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CATHERINE
Other - Last Name:NERGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27131 FULSHEAR BEND DR
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1231
Mailing Address - Country:US
Mailing Address - Phone:281-612-0050
Mailing Address - Fax:
Practice Address - Street 1:1930 PEARLAND PKWY STE 154
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5379
Practice Address - Country:US
Practice Address - Phone:281-816-5503
Practice Address - Fax:281-816-5504
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR8236207N00000X
TXBP10060357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine